What term refers to determination of the amount paid by a third-party payer for a specific procedure before the procedure is conducted?

• A. Pre-certification
• B. Premium
• C. Deductible
• D. Pre-authorization

Answer: (A)

Securing payment details before a procedure happens is about getting prior approval from the payer. This step, called pre-certification, involves submitting the planned procedure for review and obtaining authorization that the plan will cover it and what portion it will pay. Having this in place clarifies financial responsibility upfront for both the provider and the patient and helps prevent surprise denials or large bills after the service.

Premium refers to the regular payment you make to maintain insurance coverage. A deductible is the amount a patient must pay out of pocket before benefits kick in. Pre-authorization is a closely related concept focused on confirming medical necessity of the procedure, but the term that directly reflects determining the payer’s payment ahead of time is pre-certification.